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MEDICAL   NOTES 

IN 

EGYPT 


BY 

FREDERICK   PETERSON,  M.D., 

PROFESSOR   OF  NERVOUS    DISEASES    IN  THE    UNIVERSITY    OF    VERMONT  J     CHIEF  OF 
CLINIC,  NERVOUS   DEPARTMENT,   COLLEGE  OF   PHYSICIANS  AND  SURGEONS, 
NEW  YORK;    PATHOLOGIST  TO  THE  NEW  YORK   CITY  INSANE 
ASYLUMS  ;   ATTENDING  PHYSICIAN  TO  THE   NEW   YORK 
HOSPITAL    FOR    NERVOUS  AND   EPILEPTIC  ;     AT- 
TENDING   PHYSICIAN    TO  ST.  SAVIOUR'S 
SANITARIUM    FOR     INEBRIATE 
WOMEN,  NEW  YORK  CITY. 


NEW  YORK 

M.  J.  ROONEY,  PRINTER  and  PUBLISHER, 

1 14-120  West  30TH  Street 

1893 


MEDICAL   NOTES 

IN 

EGYPT 


BY 

FREDERICK   PETERSON,  M.D., 

PROFESSOR    OF   NERVOUS    DISEASES    IN   THE    UNIVERSITY    OF    VERMONT  ;     CHIEF   OF 
CLINIC,  NERVOUS   DEPARTMENT,    COLLEGE   OF   PHYSICIANS   AND   SURGEONS, 
NEW   YORK  ;     PATHOLOGIST  TO   THE  NEW   YORK   CITY   INSANE 
ASYLUMS  ;   ATTENDING   PHYSICIAN   TO   THE   NEW   YORK 
HOSPITAL     FOR    NERVOUS   AND   EPILEPTIC  ;     AT- 
TENDING   PHYSICIAN    TO   ST.  SAVIOUR'S 
SANITARIUM    FOR     INEBRIATE 
WOMEN,  NEW  YuRK  CITY. 


NEW  YORK 

M.  J.  ROONEY,  PRINTER  and  PUBLISHER, 

1 14-120  West  30TH  Street 

1893 


2 
O 

en 

#-* 

>- 


WINTERING  IN  EGYPT- 


There  is  probably  no  other  country  in  the  world  so 
delightful  as  Egypt  for  a  winter  sojourn.  It  is  equally 
fascinating  for  the  traveller  in  search  of  recreation  and 
for  the  invalid  in  quest  of  health.  One  is  placed  in  an 
environment  at  once  tonic  to  the  mental  and  physical 
organization.  The  western  mind,  whether  healthy  or 
morbid,  is  certain  to  be  both  pleasantly  impressed 
and  deeply  stirred  on  beholding  strange  races,  curious 
costumes,  oriental  manners  and  habits,  Saracenic 
architecture,  a  land  of  deserts,  oases,  palms,  and  the 
river  Nile,  a  land  abounding  in  magnificent  monu- 
ments of  an  ancient  civilization,  and  over  all  of  which 
hangs  unchangeably  a  vivid,  cloudless,  splendid  sky. 
Change  in  itself  is  always  a  tonic,  strong  in  a  direct 
ratio  to  the  amount  of  novelty,  and  where  this  thera- 
peutic agent  is  indicated  in  its  most  powerful  form, 
Egypt  must  be  the  prescription. 

For  the  invalid  Egypt  has  remedial  qualities  which 
are  entirely  her  own,  and  not  to  be  found  elsewhere, 
modes  of  life  which  are  restful,  peculiarities  of  climate 
which  are  unique.  It  must  be  taken  into  considera- 
tion, too,  that  this  desirable  resort  is  not  so  far  from 
our  shores  as  it  may  seem,  and  that  the  time  of  travel 
is  being  gradually  reduced.  Alexandria  is  five  or  six 
days  from  London.  It  is  but  twelve  to  fourteen  days 
from  New  York  (North  German  Lloyd  to  Genoa  eight 
to  nine  days,  rail  to  Brindisi  one  day,  P.  &  O.  steamer 
to  Egypt  three  days;  or  to  Paris  eight  days,  rail  to 
Marseilles  fourteen  hours,  French  Packet  to  Alexan- 
dria four  to  five  days). 

*From  the  N.   Y.  Medical  Record,  Aug.  20,  1892. 


Egypt  is  a  narrow  green  ribbon  of  land,  with  the 
Nile,  not  as  broad  as  the  Missouri  River,  flowing 
through  it,  and  endless  stretches  of  desert  on  either 
side.  These  thousands  of  square  miles  of  barren  dry- 
sand  rob  the  air  of  most  of  its  moisture,  dissipate 
clouds  and  prevent  rains,  and  completely  sterilize  the 
atmosphere  of  pestiferous  germs. 

The  climate  of  the  Delta  is  not  treated  in  this  article, 
because  no  part  of  it  can  be  considered  a  health-re- 
sort for  Americans  or  Europeans  (many  residents  of 
Egypt  spend  their  summers  at  Ramleh  or  Alexandria), 
and  because  it  differs  materially  from  the  rest  of 
Egypt.  For  instance,  Cairo,  which  lies  at  the  upper 
angle  of  the  Delta,  has  twelve  rainy  days  in  the  year, 
while  at  its  other  extremity,  Damietta  and  Alexandria, 
rain  is  still  more  frequent. 

Interesting  and  charming  as  Cairo  is  to  most  peo- 
ple, it  is  not  here  that  the  invalid  should  take  up  his 
winter  residence,  although  he  may  make  it  his  head- 
quarters from  which  to  depart  on  his  various  excur- 
sions. The  general  sewer  system  of  Cairo  is  in  very 
bad  condition,  but  that  of  most  of  the  hotels  is 
good.  The  mortality  of  Cairo  is  extraordinary,  almost 
equal  to  that  of  Madras.  The  Cairo  death-rate  is  46 
in  1,000;  Madras,  48;  Paris  and  Berlin,  23.50;  Lon- 
don, 17.4.  In  winter  one  may  spend  some  very 
miserable,  cold,  damp  days  in  Cairo,  for  the  hotels 
are  rarely  provided  with  means  of  heating  the  rooms, 
and  few  of  them  have  a  sufficiency  of  chambers  with 
a  southern  exposure.  I  experienced  about  Christmas 
time,  last  year,  four  most  uncomfortable  rainy  and 
cold  days  in  succession  in  Cairo,  and  suffered  more 
from  it  than  one  winter  month  in  Florence,  some 
years  ago,  treasured  up  as  one  of  my  bitterest  memo- 
ries of  disillusion  in  sunny  Italy. 

Season. — The  season  for  tourist  or  invalid  is  the 
seven  months  from  October  to  April,  inclusive,  but 
one  may  remain   through   May  without  discomfort. 


The  other  months  are  objectionable  because   of  the 
heat  and  the  inundation  of  the  Nile. 

The  seeker  after  health  has  one  of  three  courses 
open  to  him  on  reaching  Egypt.  He  should  either 
go  into  winter  quarters  at  Helouan,  Gizeh,  or  Luxor — 
take  a  dahabeeyeh  voyage  up  the  Nile  for  three  or 
four  months,  or  go  on  camping  excursions  in  the 
desert.  This  last  suggestion  will  be  a  novel  one,  I 
think,  to  the  European  physicians  who  send  patients 
to  Egypt  and  to  the  physicians  residing  there,  but  it 
was  very  apt  to  occur  to  an  American  physician, 
familiar  with  some  of  our  tent  hospitals,  and  the 
benefits  to  great  numbers  of  invalids,  especially  con- 
sumptives, of  camping  trips  in  our  Rocky  Mountain 
regions.  Camping  has  advantages  in  Egypt,  too, 
that  are  never  to  be  obtained  in  America,  the  abso- 
lute certainty  of  warm  sun  and  rainless  days,  and  the 
means  of  carrying  any  quantity  of  necessities  and 
luxuries  in  the  way  of  edibles  and  household  furni- 
ture. 

Before  describing  specifically  these  courses,  how- 
ever, it  will  be  well  to  consider  the  climatological 
features  of  Egypt  in  detail.  Most  of  the  observations 
at  our  command  have  been  made  at  the  Khedivial 
Observatory  at  Cairo,  and  while  these  answer  fairly 
well  for  Helouan  and  Gizeh,  which  are  in  the  imme- 
diate neighborhood  of  that  city,  there  are  unfortu- 
nately no  elaborate  records  as  yet  available  to  throw 
light  upon  the  climatological  conditions  of  Luxor, 
four  hundred  and  fifty  miles  farther  south,  or  out  in 
the  desert  at  various  distances  from  the  Nile  Valley. 
Dr.  F.  M.  Sandwith,  of  Cairo,  in  his  admirable  book, 
''Egypt  as  a  Winter  Resort,"  has  made  a  careful 
study  of  the  observatory  records,  and  also  of  such 
others  as  have  been  communicated  by  physicians  in 
their  journeys  up  the  Nile,  and  to  this  book  I  am 
mainly  indebted  for  the  following  statistical  facts  as 
to  the  Egyptian  climate.     Where  it  seemed  to  me  ad- 


vantageous  for  the  reader,  I  have  introduced  figures 
for  comparison  with  other  health-resorts. 

Elevation  above  Sea-level. — Helouan,  Gizeh, 
Cairo,  iooto  200  feet;  the  Mokattarh  Hills,  just  back 
of  Cairo,  600;  Luxor,  292. 

Temperature. — The  Cairene  isothermal  line  runs 
between  Algiers  and  Santa  Cruz,  and  Florida  and 
Canton.  Freezing-point  is  never  reached  in  Cairo, 
but  absolute  minima  of  350  and  360  F.  were  noted  on 
two  nights  in  January,  1887  and  1888,  respectively. 
The  desert  is  sometimes  piercingly  cold  at  night,  as 
I  found  in  a  camping  trip  to  the  Wadi  Natroon. 
Water  in  a  shallow  dish  will  occasionally  freeze  on 
exposure  to  a  desert  night  wind.  The  thermometer 
readings  for  the  seven  seasonable  months  may  be 
best  judged  by  reference  to  the  following  table  (Fahr. ) 


October  . . 
November. 
December 
January. . . 
February  . 

March 

April   


Mean    f 

Mean  ot 

Maxima. 

Minima. 

Dearees. 

Degrees. 

84.O 

64.8 

74.2 

56-3 

67.7 

5°-4 

61.4 

46.6 

65.3 

48.8 

73-2 

53-o 

81.2 

59-9 

Mean 
of  Me   ns. 


Degrees. 

74.3 
64.4 

58.4 

53-6 
57.o 
62.8 

7^4 


Rainfall. — Cairo,  a  trifle  over  one  inch  annually, 
distributed  over  twelve  to  fifteen  days  of  the  winter 
months.  The  same  figures  for  Helouan  and  Gizeh. 
At  Luxor  it  is  not  quite  true,  as  has  been  facetiously 
stated,  that  "it  rains  only  once  in  4,000  years,"  but 
rain  is  so  rare  a  phenomenon  that  the  date  and  dura- 
tion of  a  shower  are  carefully  recorded,  not  only  by 
Luxor  residents,  but  by  transient  travellers,  as  an  ex- 
traordinary experience.  Showers  were  noted  once  in 
1882,  once  in  1887;  and  Dr.  Boase  remarked  a  three- 
minute  rain  in  1888. 


It  is  interesting  to  compare  statistics  as  to  the 
annual  rainfall  in  various  resorts,  although  this  is  not 
as  important  as  to  ascertain  the  number  of  cloudy  and 
rainy  days  at  any  health  station  during  the  season. 


Luxor. 


Cairo 

Hyeres 

Algiers 

Pau 

Nantucket 

Aiken  

Jacksonville 

Denver 

Los  Angeles 

White  Mountains, 


Annual  rainfall  in 
inches. 


Minute  fraction 

of  inch,  if  any. 

i 

33-5° 
32 
43 

46.48 

55-93 
n. 41 

13.13 

5o 


Number  of  rainy 
days  during  seven 
months  ;  winter 
season. 


Usually  none. 

12 

32 
71  (six  months) 
50  (six  months) 

91 
41  (six  months) 

72 
39 
45 
87 


Dew. — In  Lower  Egypt,  along  the  Nile,  and  in  the 
desert  near  the  Nile,  dews  are  always  present,  so  that 
walking  in  the  green  fields  at  night,  and  up  to  nine 
o'clock  in  the  morning,  is  unpleasant.  At  Luxor  and 
the  First  Cataract,  dew  is  almost  unnoticeable. 

Humidity. — The  most  valuable  feature  of  the 
Egyptian  climate  is  its  dryness.  At  Cairo  the  relative 
humidity  is  least  in  June  (44),  and  the  annual  average 
relative  humidity  is  58.4;  but  for  the  seven  months 
during  which  Cairo  is  frequented  by  invalids,  the 
average  is  higher,  63.2  (London  over  90  in  winter). 
This  I  base  upon  Dr.  Sandwith's  table  from  the  Ob- 
servatory records  for  five  years.  It  must  be  remem- 
bered that  this  Observatory  is  situated  near  the  river 
and  at  the  apex  of  the  Delta.  Often,  even  at  Cairo, 
the  humidity  on  individual  days  is  phenomenally 
low,  for  instance,  down  to  3  one  day  in  April,  1887, 
and  once  4  in  March,  1888.  These  figures  apply  also 
to  Helouan  and  Gizeh.     As  regards  the  humidity  at 


8 

Luxor,  there  are  as  yet  but  few  figures  at  command,  but 
from  such  as  have  been  taken,  we  learn  that  the  air 
there  is  much  dryer  than  at  Cairo,  the  average  being 
twelve  to  fifteen  per  cent.  less.  Thus  far  no  obser- 
vations as  to  this  important  particular  have  been 
made  in  the  desert  proper,  remote  from  the  Nile. 
Undoubtedly  there  the  humidity  is  still  less,  probably 
the  least  of  any  place  in  the  world,  and  it  is  to  be 
hoped  that  desert  records  will  ere  long  be  made.  The 
following  table  will  illustrate  the  difference  in  mean 
annual  humidity  of  various  places  in  the  world. 


Asheville,  N.    C.  (Gleits- 

man) 70.10 

Mt.  Washington 86.00 

Florida  (Jacksonville) . .  .68.00 
Adirondacks  (Skinner). .  .70.50 


Luxor 50 .5 

Cairo 584 

Greenwich 87.0 

Algiers 70. 7 

New  York   73.0 

Aiken  (Geddings) 64.04 

Air-pressure. — The  barometric  readings  at  the 
Khedivial  Observatory  for  five  years  show  an  average 
of  29.86,  never  above  29.99  m  anv  month.  Com- 
paring this  mean  air-pressure  with  some  other  health- 
resorts,  we  have  : 

Cairo  (Sandwith) 29.86 

Nice  (Collier) 29.60 

Hyeres  (Cormack, 30. 16 

Clouds. — Not  infrequent  at  Cairo.  In  the  desert 
and  at  Luxor,  almost  unknown. 

Winds. — The  prevailing  wind  at  Cario  is  from  the 
north;  in  January,  however,  from  the  southwest. 
The  average  force  in  miles  calculated  by  the  anemom- 
eter is  2.9  for  the  year,  but  for  the  seven  winter 
months  is  abated  to  an  average  of  2.3. 

At  Luxor  the  prevailing  winds  from  November  to 
March,  inclusive,  are  southwest,  northeast,  and 
northwest,  and  the  average  force  in  miles  for  these 
five  months  is  exceedingly  low,  0.9. 

None  of  the  winds  in  Egypt  are  uncomfortable  or 
dangerous,  like  the  fohn,  mistral,  sirocco,  and  solano, 


of  some  other  resorts,  with  perhaps  the  exception  of 
the  khamseen.  Khamseen  is  the  Arabic  word  for 
"fifty,"  and  the  wind  is  thus  named  because  it  is  apt 
to  blow  during  some  of  the  fifty  days  following 
Easter  Monday.  The  number  of  khamseen  days  in  a 
year  varies  from  4  to  20.  It  blows  for  three  days  as 
a  rule,  but  may  continue  longer.  It  is  very  dry  and 
hot,  and  the  air  is  commonly  loaded  with  fine  sand. 
It  comes  from  the  south  or  southwest.  I  experienced 
one  day  of  khamseen  in  the  Lybian  desert  while 
travelling  by  camel  in  a  small  caravan,  in  January 
last,  but  did  not  find  it  very  uncomfortable.  Accord- 
ing to  Dr.  Sandwith,  "the  general  effects  are  a  little 
excitement  and  stimulation  of  the  system,  a  more 
rapid  succession  of  ideas,  and  increased  action  of 
some  of  the  functions,  followed  by  listlessness,  head- 
ache, and  languor/' 

Water-supply. — The  water  of  the  Nile,  or  of  wells 
in  the  Nile  Valley,  is,  of  course,  used  altogether  by  the 
residents.  Visitors  often  drink  nothing  but  bottled 
waters,  such  as  Apollinaris  and  Giesshlibler,  but  with 
proper  filtration  there  is  no  water  in  the  world  supe- 
rior to  Nile  water  for  drinking  purposes.  The  Cairo 
water  company  filters  its  water.  Every  dahabeeyeh 
and  steamer  on  the  river,  and  every  house  in  Cairo 
and  other  large  towns,  is  supplied  with  huge  earthen 
jars,  through  the  bottom  of  which  the  water  filters 
pure  and  glistening  drop  by  drop.  This  is  on  the 
same  principle  as  the  Pasteur  filter  now  coming  into 
general  use  in  America  and  elsewhere,  and  it  answers 
the  purpose  perfectly.  It  is  needless  to  say  that  un- 
filtered  water  should  never  be  drunk  in  Egypt. 

Prevailing  and  Uncommon  Diseases. — Diar- 
rhoea is  common  among  the  natives,  and  visitors  oc- 
casionally suffer  from  it  unless  they  are  duly  cautious 
as  regards  warm  abdominal  clothing.  Typhoid  fever, 
typhus,  measles,  and  relapsing  fever  are  not  infre- 
quent in  the  overcrowded  and  filthy  native  quarters, 


IO 

and  there  are  some  forty  deaths  from  small-pox  in 
Cairo  annually.  Diphtheria  prevails  to  a  certain  ex- 
tent. Scarlatina,  whooping-cough,  and  mumps  are 
very  rare.  Pleurisy,  bronchitis,  and  pneumonia  are 
frequent,  but  only  from  a  careless  exposure  at  night; 
for  the  night  is  often  a  strong  contrast  to  the  day  in 
point  of  temperature.  Malaria  in  a  mild  form  is  fre- 
quent along  the  river  in  the  warm  months. 

Consumption  is  almost  unknown.  The  Egyptians 
seem  scarcely  ever  to  have  it,  but  the  blacks  from  the 
far  South  (Nubia,  Abyssinia,  Soudan),  on  coming  to 
Lower  Egypt,  which  is  damp  and  cold  in  comparison 
with  their  native  land,  are  subject  to  it. 

Entozoal  disorders  are  common,  and  I  saw  several 
cases  of  anchylostoma  duodenale  with  Dr.  Sandwith 
at  the  Kasr-el-Aini  Hospital.  Ophthalmia,  as  is  well 
known,  is  extraordinarily  prevalent  in  Egypt,  and  has 
been  for  thousands  of  years,  but  foreigners  seldom 
suffer  from  it.  Sunstroke  is  rarer  than  one  might 
suppose,  and  the  remarkable  precautions  taken  by 
some  tourists  to  protect  their  heads  are  quite  unneces- 
sary. 

Acute  rheumatism,  gout,  and  rheumatoid  arthritis 
are  practically  unknown  in  Egypt. 

I  was  myself  especially  interested  in  insanity  and 
nervous  diseases  among  the  Egyptians.  Elsewhere 
I  have  called  attention  to  the  phenomenal  rarity  of 
insanity  and  the  entire  absence  of  paralytic  dementia 
among  the  Egyptians.1  Egypt  with  six  millions  in- 
habitants, has  but  one  asylum,  containing  two  hun- 
dred and  fifty  inmates,  whereas  New  York  State,  with 
the  same  population,  has  over  fifteen  thousand  insane 
in  its  numerous  asylums. 

I  observed  several  cases  of  chronic  poliomyelitis, 
and    numerous   infantile   spastic  paralyses,   most  of 


1  Insanity  in  Egypt,  by  Frederick  Peterson,  Medical  Rec- 
ord, May  21,  1892. 


II 

them  making  a  living  by  begging  through  the  streets 
or  around  monuments  and  tombs.  The  climate  of 
Egypt  is  so  favorable  and  food  so  cheaply  and  easily 
obtained,  that  such  cases  as  would  with  us  be  put  into 
hospitals  for  incurable  diseases,  here  live  out-of- 
doors,  sleeping  where  they  like,  and  satisfying  their 
hunger  with  a  piece  of  native  bread  thrown  to  them, 
and  an  onion  or  two  taken  from  a  neighboring  field. 
Wherever  I  would  go  I  found  it  easy  to  establish  an 
out-of-door  clinic,  for  as  soon  as  it  was  understood 
that  I  was  a  physician,  my  tent  or  boat  would  be 
sought  by  any  number  of  applicants  for  medical  ad- 
vice and  drugs. 

Diseases  Improved  and  Cured  by  the  Climate 
of  Egypt. — This  climate  is  invaluable  in  all  manner 
of  chronic  diseases  of  the  respiratory  organs,  for  deli- 
cate lungs  or  incipient  phthisis,  for  rheumatic  affec- 
tions, for  convalescents  from  any  acute  disease.  As 
Dr.  Sandwith  aptly  remarks,  the  most  important  ques- 
tion really  is  to  determine  what  kinds  of  patients  not 
to  send  to  Egypt.  As  to  this,  each  consulted  physi- 
cian must  decide  upon  the  merits  of  individual  cases. 
It  is  almost  needless  to  say  that  moribund  phthisical 
patients,  or  invalids  with  apoplectic  tendencies, 
should  not  be  sent  to  Egypt. 

There  is  no  doubt  that  a  voyage  on  the  Nile,  or  a 
residence  in  Cairo,  Gizeh,  Helouan,  or  Luxor,  or  camp 
life  in  the  desert,  is  a  valuable  indication  in  many 
forms  of  nervous  and  mental  disease,  such  as  neuras- 
thenia, insomnia,  over-work,  hypochondriasis,  hys- 
teria, melancholia  simplex,  and  other  mild  forms  of 
incipient  or  threatened  insanity.  There  is  no  better 
climate  for  intractable  rheumatic  and  malarial  neural- 
gias, sciatica,  and  the  like. 

Having  given  these  preliminaries,  it  now  remains 
to  consider  briefly  the  means  of  taking  the  best  ad- 
vantage of  what  Egypt  offers  to  invalids. 


I  2 

Gizeh,  Helouan,  Cairo. — On  reaching  Egypt  one 
disembarks  at  Alexandria  preferably  (though  one  may 
also  land  conveniently  at  Ismailia),  and  then  makes 
his  way  by  rail  at  once  to  Cairo,  where  he  takes  a 
sunny  room  at  one  of  the  good  hotels  (Shepheard's, 
Continental,  New,  or  Royal),  and  prepares  his  plans 
for  the  winter.  If  a  physician  is  needed  there  are 
many  good  English  and  German  physicians  in  Cairo. 

Gizeh  and  Helouan  are  the  sanatoria  of  Cairo.  Both 
are  in  the  desert,  and  both  within  easy  reach  of  the 
city  and  good  medical  care. 

At  Gizeh,  seven  miles  from  Cairo,  is  merely  an  Eng- 
lish hotel  (the  Mena  House)  on  the  edge  of  the  desert, 
and  almost  in  the  shadow  of  the  three  great  pyramids 
and  the  Sphynx.  It  is  as  perfect  in  all  of  its  appoint- 
ments, sanitary  arrangements,  water  supply,  etc.,  as 
any  hotel  can  be.  Rooms  with  fireplaces  and  sun- 
shine can  be  obtained.  Horses,  carriages,  camels, 
and  donkeys  are  on  hand.  A  coach  runs  to  the  city 
daily.  There  is  a  good  library  and  reading-room, 
billiard-room,  tennis-court,  golf  links,  archery  and 
cricket  ground,  swimming-bath,  and  a  resident 
physician.  The  advantages  here  are  the  warm,  dry, 
aseptic  air  of  the  desert,  the  quiet  surroundings,  the 
nearness  to  Cairo,  and  the  interesting  monuments  of 
antiquity. 

Helouan  I  have  described  more  in  detail  in  another 
article.2  It  lies  fifteen  miles  to  the  south  of  Cairo, 
and  is  reached  by  numerous  trains  daily  in  forty 
minutes.  I  will  say  here  that  the  Egyptian  railway 
trains  are  much  superior  in  point  of  comfort  and  speed 
to  most  continental  trains.  There  are  two  hotels  at 
Helouan,  and  there  are  a  great  many  pretty  villas 
that  may  be  hired  for  the  season.  The  village  is 
about  three  miles  from  the  Nile,  and  very  near  the 

8  An    Ancient   Spa,    by    Frederick    Peterson,    New    York 
Medical  Journal,  1892. 


13 

great  cliffs  of  the  Mokattam  range.  The  chief  attrac- 
tion here  is  the  sulphur,  iron,  and  saline  thermal 
springs.  The  baths  are  well  constructed  and  under 
European  supervision.  This  is  the  place  par  excellence 
for  chronic  rheumatism  and  gout.  One  is  really  within 
easier  reach  of  Cairo  here  than  at  Gizeh.  The 
desert  surrounds  the  little  town.  There  are  the  usual 
amusements  of  a  spa  in  Europe,  and  in  addition  his- 
torical attractions — the  ancient  quarries  near  by,  and 
the  pyramids  of  Sakkarah  and  remains  of  Memphis 
just  across  the  river. 

Luxor. — It  has  already  been  stated  that  Luxor  is 
dryer,  warmer,  and  sunnier  than  any  of  the  resorts 
about  Cairo.  By  next  season  there  will  probably  be 
trains  running  the  whole  distance  of  four  hundred 
and  fifty  miles  from  Cairo  south  to  Luxor,  but  at 
present  one  takes  a  sleeping  car  to  Assiout  (twelve 
hours),  and  goes  thence  by  steamer  or  dahabeeyeh. 
Luxor  has  two  good  hotels  and  an  English  physician. 
The  town  has  four  thousand  inhabitants.  Close  by 
are  the  temples  and  ruins  of  Luxor,  Karnak,  and 
Thebes.  There  is  postal  and  telegraphic  communica- 
tion with  all  parts  of  the  world. 

The  hotel  prices  in  Egypt  are  all  rather  below  those 
charged  in  most  American  health-resorts. 

These  three  places,  Gizeh,  Helouan,  and  Luxor, 
are  the  chief,  in  fact  the  only,  resorts  in  Egypt  for  in- 
valids who  intend  making,  or  are  compelled  to  make, 
a  protracted  stay  in  a  hotel.  I  have  no  doubt  that  in 
time  other  and  still  better  sanatoria  will  be  established 
in  spots  still  better  adapted  to  make  use  of  the  won- 
derful properties  of  the  desert  climate — places  perhaps 
remote  from  the  Nile  and  its  seven  inches  per  month 
of  evaporating  water,  and  which  will  be  desert  health- 
resorts  in  every  sense  of  the  word. 

The  Nile  Voyage. — If  there  is  anything  in  life 
which  will  steal  away  worries  and  cares,  soothe  the 


14 

tired  brain,    calm  the   unstrung   nerves,    bring  back 
vagrant  sleep, 

"  Administer  to  a  mind  diseased, 
Pluck  from  the  heart  a  rooted  sorrow," 

it  is  the  dream-like  voyage  on  the  Nile  in  a  dahabee- 
yeh.  At  an  expense  of  $600  to  $800  per  month  four 
people  have  a  house-boat,  four  bed-rooms,  dining- 
room,  sitting-room,  bath-room,  large  deck  with 
awning,  captain  and  crew  of  eight  to  ten  or  more 
men,  cook,  waiter  interpreter,  and  food  for  all.  One 
may,  if  one  wishes,  pay  twice  as  much  for  the  same 
thing,  for  there  are  always  tourist  companies  or  drag- 
omans willing  to  receive  it,  but  it  is  not  necessary, 
as  I  have  demonstrated  by  experience.  In  a  daha- 
beeyeh  you  are  the  plaything  of  the  wind,  but  although 
I  have  spent  as  many  as  eighteen  days  on  one  oc- 
casion in  traversing  a  distance  of  one  hundred  and 
eighty  miles,  owing  to  contrary  winds,  there  never 
was  a  day  or  an  hour  that  hung  heavily  on  the  hands, 
for  there  is  so  much  to  do  and  so  much  to  see.  Per- 
haps this  voyage  has  the  peculiar  and  rare  quality  of 
making  dole e  far  niente  appear  in  its  busiest  aspect. 
At  any  rate,  one  is  so  much  occupied  with  something 
that  the  weeks  pass  before  one  realizes  it.  This  is  not 
the  place  to  describe  how  this  illusion  is  produced  of 
being  very  much  occupied,  when  you  are  in  reality 
resting  and  imbibing  new  vitality,  mental  and  physi- 
cal ;  books  enough  have  been  written  about  it  to  dam 
the  Nile,  as  someone  has  observed,  and  to  these  the 
reader  is  referred  for  further  particulars. 

As  there  are  no  means  of  heating  a  dahabeeyeh  on 
cold  nights,  braziers  not  being  advisable,  a  Rochester 
lamp  burning  in  the  sitting-room  will  be  found  to 
answer  every  purpose.  An  assortment  of  books, 
some  guns,  a  telescope,  a  photographic  outfit,  and 
other  instruments,  scientific  or  musical,  which  indi- 
vidual tastes  may  suggest,  will  be  found  useful  and 


15 

agreeable  adjuncts  to  such  a  trip.  The  voyage  should 
begin  about  mid-December  and  be  continued  at  pleas- 
ure for  three  or  four  months. 

The  advantages  of  the  dahabeeyeh  voyage  over 
residence  in  one  place  are  obvious.  There  are  the 
same  climatic  features  as  elsewhere  in  Egypt.  It  is 
like  living:  in  one's  own  home  instead  of  in  a  hotel. 
There  is  change  every  day,  and  indeed  every  hour. 

No  other  river  in  the  world  could  be  travelled  in 
this  way.  The  dahabeeyeh  would  never  be  a  success 
upon  the  Indian  River,  St.  John's,  Hudson,  or  Miss- 
issippi. It  might  be  on  the  Amazon.  But  all  along 
the  Nile  are  famous  ruins,  temples,  tombs,  relics  of 
the  world's  most  ancient  civilization,  which  in  them- 
selves excite  the  interest  of  every  traveller,  whether 
in  good  or  poor  health. 

Cook's  steamers  will  do  very  well  for  the  wildly- 
rushing  tourist,  who  is  willing  and  perhaps  able  to 
endure  any  amount  of  haste  crowding,  and  discom- 
fort, but  for  invalids  the  dahabeeyehs  are  the  only 
boats  to  be  recommended.  A  tug  to  tow  the  daha- 
beeyeh is  another  evil  that  affords  no  adequate  com- 
pensation for  its  noise  and  smoke. 

Cook  &  Sons  have  dahabeeyehs  also,  and  while  they 
are  magnificent  boats  their  charges  are  proportionally 
high,  being  three  times  what  one,  sufficiently  comfort- 
able for  anyone,  can  be  obtained  for  by  application  to 
private  owners.  The  average  dragoman  asks  only 
twice  as  much  as  it  is  worth.  By  hiring  an  interpreter 
for  the  voyage  and  exercising  only  a  little  discre- 
tion and  supervision  in  purchases  and  payments,  the 
Nile  voyage  comes  within  the  means  of  many  people 
of  moderate  circumstances  whom  Cook's  prices  would 
otherwise  debar  from  its  advantages.  But  an  invalid 
with  unlimited  means  will,  of  course,  find  Cook  or 
Gaze  useful  agents  in  attending  to  everything  con- 
nected with  the  Nile  trip,  thus  saving  considerable 
trouble. 


i6 

Camping-out  in  Egypt. — Camp  life  in  Egypt  is 
something  luxurious.  I  have  camped  out  on  shoot- 
ing expeditions  in  Nebraska,  Dakota,  and  other  West- 
ern places,  and  endured  hardships  that  I  should  not 
care  to  experience  again.  But  in  Egypt,  where  labor 
and  carrying  cost  next  to  nothing,  where  everything 
in  the  way  of  furniture  and  supplies  can  be  stored 
away  somewhere  on  a  camel,  where  every  day  can 
be  foreseen  to  be  rainless  and  beautiful,  life  in  tents 
becomes  a  pleasure. 

It  is  always  well  to  have  some  objective  point  in 
view  to  reach,  and  among  the  pleasantest  desert  trips 
with  tents  and  camels  are  those  to  theSinaitic  Penin- 
sula, to  the  Natroon  Lakes,  to  the  Fayoum,  and  to 
several  other  oases  to  the  west  of  the  Nile.  Probably 
the  warmest  and  dryest  for  an  invalid  would  be  that 
from  Assiout,  Geergeh,  or  Eseh  to  the  Great  Oasis. 
But  one  may  camp  on  the  edge  of  the  desert,  travel- 
ling southward  along  the  Nile,  in  that  way  having  the 
advantage  of  more  interesting  surroundings;  for  some 
people  might  find  the  desert  monotonous.  For  those 
who  enjoy  shooting,  camping  in  the  Delta  or  the 
Fayoum,  or  anywhere  along  the  Nile  affords  ample 
opportunity  for  the  gratification  of  this  taste.  There 
is  nowhere  in  Egypt  any  very  large  game;  a  few  wild 
boar,  hyenas,  jackals  wolves,  foxes,  and  unattain- 
able gazelles;  ibex  in  Sinai.  But  this  land  is  the 
winter  home  of  all  the  European  aquatic  birds,  ap- 
parently, and  wild  pigeons,  snipe,  quail,  plover,  also 
abound  in  phenomenal  numbers.  As  for  quail,  we 
shot  about  one  hundred  and  twelve  in  three  hours 
with  three  guns,  two  of  us  being  indifferent  shots. 
We  made  shooting  excursions  through  the  Delta,  to 
the  oasis  of  the  Fayoum,  and  to  Wadi  Natroon.  As 
an  example  of  the  methods  of  camping  here,  I  will 
briefly  describe  our  equipment  for  the  trip  to  Wadi 
Natroon,  where  we  spent  ten  days.  We  were  a  party 
of  three,  and  had  eight  camels  with  their  drivers,  a 


17 

dragoman  (interpreter),  desert  guide,  cook,  hunter- 
guide,  and  a  boy,  two  tents,  three  folding  bedsteads 
with  mattresses,  two  folding  tables  chairs,  rugs, 
cook-stove,  fuel,  water,  rifles  and  shot-guns,  and  pro- 
visions for  all  the  party,  camels  included.  Camel- 
riding  becomes  easy  after  a  time.  One  can  assume 
almost  any  position,  even  lying  down  and  going  to 
sleep,  and  one  can  read  with  ease.  Ladies  are  not  at 
all  debarred  from  taking  such  trips.  Everything 
necessary  can  be  procured  in  Cairo,  and  the  expense 
should  not  be  over  $5  to  $7  per  day  for  each  traveller. 

While  we  in  America  frequently  enough  recommend 
camp  life  in  the  West  to  certain  of  our  patients,  I  be- 
lieve thus  far  it  has  never  been  advised  by  authorities 
on  Egyptian  climate,  probably  through  lack  of  famil- 
iarity with  its  value  and  practicability.    . 

Clothing. —  Winter  clothing  should  be  used  in 
Lower  Egypt,  autumn  clothing  in  Upper  Egypt,  and 
in  the  desert  and  on  the  Nile.  Heavy  wraps  will  be 
found  useful  at  night. 

Books. — The  best  book  of  reference  for  the  physi- 
cian and  invalid  is  Dr.  F.  M.  Sandwith's  "Egypt  as  a 
Winter  Resort"  (Kegan  Paul,  Trench  &  Co.,  London). 
The  best  popular  literary  book  is  Charles  Dudley 
Warner's  "  My  Winter  on  the  Nile."  Both  Baedeker 
and  Murray  publish  guide  books,  one  of  which  is  in- 
dispensable. 


THE   BATHS  OF  HELWAN, 

OR 
AN    ANCIENT   SPA.* 

The  Baths  of  Helwan,  in  Egypt,  perhaps  merit  the 
distinction  of  being  the  oldest  health  resort  of  the 
world,  and  while  their  situation  in  so  remote  a  country 
as  Egypt  may  not  make  a  reference  to  them  so  valu- 
able to  American  physicians  as  it  otherwise  might  be, 
still  it  may  have  a  historical  interest  to  many  of  your 
readers,  and  a  few  may  find  some  practical  use  in  the 
following  notes  of  a  recent  visit,  for  the  travel  of 
American  invalids  in  this  direction  is  becoming 
greater  year  by  year. 

While  I  have  spoken  of  the  Helwan  springs  as  the 
most  ancient  spa  of  the  world,  their  early  history  is 
somewhat  obscure.  It  seems  reasonably  certain, 
however,  that  during  the  eighteenth  dynasty,  or  some- 
thing over  thirty-five  hundred  years  ago,  King  Amen- 
hotep  sent  persons  afflicted  with  leprosy  and  other 
incurable  diseases  to  these  springs  for  treatment. 
There  are  perfectly  authentic  records  of  their  being  a 
health  resort  twelve  hundred  years  ago,  but  from  that 
time  until  a  very  recent  period  they  had  a  very  pre- 
carious existence,  as  the  various  layers  of  bricks, 
granite,  marble,  pottery,  and  the  like  found  as  ruins 
of  ancient  villages  would  seem  to  indicate.  Some- 
where about  1 87 1  the  Egyptian  Government  inaugu- 
rated a  new  era  for  these  springs  by  reconstructing 
the  baths,  building  a  hotel,  planting  trees  and  the 
like,  so  that  now  a  pleasant,  well-built  town,  with 
palm  groves  and  villas,  and  a  good  railway  from 
Cairo,  stands  where  not  long  ago  was  but  a  waste  of 
yellow  sand. 

*  From  X.    }'.  Medical  Journal,  June  25,  1 892. 


19 

Helwan  is  said  by  some  to  derive  its  name  from 
the  Arabic  word  helwi,  meaning  sweet ;  but  this 
would  hardly  be  suggested  by  the  waters,  which  are 
particularly  generous  of  their  exhalations  of  sulphu- 
reted  hydrogen.  The  modern  spa  lies  fifteen  miles 
south  of  Cairo  in  the  desert,  about  three  miles  from 
the  Nile,  and  with  about  two  miles  of  sand  interven- 
ing between  it  and  the  river.  Back  of  it  lie  the  bar- 
ren, fantastic,  and  precipitous  cliffs  of  Mokattam.  It 
may  be  classed  with  the  desert  health  resorts,  and  as 
such  is  the  most  accessible  of  all,  while  it  partakes  of 
that  remarkable  dryness  and  purity  of  air  common  to 
such  situations.  Its  elevation  is  some  112  feet  above 
the  level  of  the  Nile.  Thus  far  about  a  dozen  springs 
have  been  rediscovered.  They  are  all  thermal,  vary- 
ing in  temperature  from  77°  to  86°  F.,  but  they  differ 
in  their  chemical  constitution,  for  some  are  sulphur- 
ous and  others  chalybeate  and  saline.  The  analyses 
made  of  most  of  them  are  as  follows  : 

Three  Sulphur  Springs. — Temperature,  86°  F.;  sp.  gr.,  1-0025. 

Analysis  of  One  Litre. 

Gases. 

Free  sulphureted  hydrogen. ...  47  c.  c,    '0731  gramme. 

"    carbonic  acid 61     "       *i2oo  " 

"    nitrogen 10     "       '0126  " 

118     "       -2057  " 

Solids. 

Sodium  chloride 3*2000  grammes. 

Magnesium  chloride 1-8105  " 

Calcium  bicarbonate -8050  gramme. 

"         sulphate -2100  " 

chloride    -1880  " 

Silica '0150  " 

Organic  matter '0015  " 

6*2300  grammes. 


20 

Two  Iroft  Springs. — Temperature,  77*  F. ;  sp.  gr.,  1-0445. 

Gas. 

Free  carbonic  acid 26  c.  c,   '0511  gramme. 

Solids. 

Sodium  chloride             37.2671  grammes. 

Magnesium  chloride         10-6020          " 

Calcium  bicarbonate 5 '9422          " 

Magnesium  sulphate 2'35°7          " 

Calcium  chloride 1*5250           " 

"        sulphate 1*0820          u 

Alumina        "        "5861  gramme. 

Sodium  bicarbonate *2255           " 

Ferrum           "             "°555 

Organic  matter ....          -0300 

Silica -0180           " 


59-6841  grammes. 

One  Saline  Spring. — Temperature,  77^  F.;  sp.  gr.,  1. 0152. 

Gas. 

Free  carbonic  acid   6  c.  c,  -01179  gramme. 

Solids. 

Sodium  chloride  4-0171  grammes. 

Magnesium  chloride 3-1158  " 

Calcium  bicarbonate 1-2569  " 

Magnesium  sulphate   1  -0798  " 

Sodium  "         -4468  gramme. 

Alumina  "         "4257 

Calcium  chloride -1610  '• 

Organic  matter '0330  " 

Calcium  sulphate    -0210  " 

Silica -oioo  " 


10-5671  grammes. 

The  chalybeate  water  is  chiefly  used  for  its  aperient, 
and  the  saline  for  its  purgative  effects.  Both  are 
odorless  and  colorless.  The  hot  sulphur  springs  are 
those  which  enjoy  the  greatest  repute  and   are  most 


21 

valuable.  As  soon  as  one  enters  the  town  their  odor 
becomes  apparent.  The  sulphur  in  the  air  turns  silver 
ornaments  black.  The  water  of  the  springs  is  at  first 
quite  clear,  but  upon  exposure  to  the  air  becomes 
covered  with  a  film  of  sulphur  and  lime  salts,  and  a 
greenish  cryptogam,  called  baregine  (from  the  Ba- 
reges waters  of  the  Pyrenees)  develops  in  it. 

The  bath-houses  are  commodious  and  luxurious, 
kept  in  good  order,  and  are  indeed  up  to  the  usual 
standard  of  similar  institutions  in  the  better-known 
health  resorts.  The  water  is  artificially  heated  to 
higher  temperatures  when  required.  A  European 
physician  is  in  charge  of  the  establishment,  and 
European  physicians  are  numerous  in  Cairo,  near  at 
hand.  The  two  hotels  are  furnished,  and  unfur- 
nished villas  to  let  afford  excellent  accommodations 
for  invalids. 

The  diseases  for  which  these  baths  are  indicated 
are  preeminently  rheumatism  and  certain  skin  dis- 
orders, and,  in  conjunction  with  the  natural  advan- 
tages of  such  springs  the  world  over,  the  incompar- 
able winter  climate  of  Egypt  is  to  be  considered. 
There  is  almost  never  rain  or  cloud  or  fog,  and  the 
mean  annual  humidity  is  certainly  less  than  that  of 
Cairo,  which  is  58.4  (Greenwich  87,  Algiers  and  New 
York  70).  The  isothermal  line  runs  between  Florida 
and  Canton  and  Algiers  and  Santa  Cruz. 

Dr.  Sandwith,  of  Cairo,  summarized  the  monthly 
bulletins  of  the  Khedivial  Observatory  for  five  years, 
finding  the  aver?ge  annual  rainfall  to  be  1.22  inches. 

While  we  in  America  make  comparatively  little  use 
of  foreign  thermal  springs,  still,  many  of  our  patients 
go  to  Aix-les-Bains,  the  springs  of  which  are  about 
the  same  in  character  as  those  of  Helwan,  and  Aix, 
as  well  as  our  own  Hot  Springs,  is  in  a  much  colder 
latitude  than  these  Egyptian  waters — a  matter  of  a 
great  deal  of  importance,  even  if  the  distance  be 
great. 


22 

It  is  needless  to  say,  too,  that  the  mind  has  more 
to  occupy  it  here  than  in  most  health  resorts,  for,  in 
addition  to  the  pleasures  common  to  all  such  places 
— such  as  social  diversions,  riding,  driving,  and  read- 
ing— there  lie  in  plain  view  across  the  river  the  Pyra- 
mids and  the  mounds  of  ancient  Memphis.  The 
modern  Egyptians  are  interesting  in  their  manners 
and  customs.  The  great  quarries  of  Toura  and  Maase- 
rah,  from  which  the  stones  of  the  Pyramids  were 
taken,  are  near  at  hand.  The  desert  is  spread  all 
around,  and,  even  if  one  be  not  a  geologist  with  an 
eye  to  the  innumerable  fossils  of  the  nummulitic  hills, 
or  a  naturalist  zealous  for  novel  additions  to  his  col- 
lections, or  an  amateur  astronomer  eager  to  gaze  upon 
a  wide  and  brilliant  expanse  of  starry  heaven,  the 
desert,  like  the  sea,  possesses  a  fascination  of  its  own 
which  is  difficult  to  define  or  impress  upon  another 
with  empty  words. 

Helwan,  Egypt,  January  20,  1892. 


THE  INSANE  IN  EGYPT.* 

It  is  well-known  that  the  population  of  the  State  of 
New  York  is  in  the  neighborhood  of  six  million,  and 
that  it  has  some  sixteen  thousand  insane  under  public 
care.  New  York  City  and  Brooklyn  together,  with 
two  million  inhabitants,  have  asylums  which  accom- 
modate at  present  over  seven  thousand  three  hun- 
dred insane.  These  statistics  are  given  as  preliminary 
to  a  description  of  the  conditions  in  Egypt,  where  I 
have  been  spending  the  winter.  When  we  turn 
from  a  contemplation  of  the  foregoing  facts  in  refer- 
ence to  one  of  the  newest  countries  in  the  world  to 
Egypt,  which  if  not  the  oldest,  can  yet  boast  of  a 
civilization  sixty  centuries  ago,  we  are  struck  by  a 
remarkable  difference.  Egypt  too  has  six  million  of 
inhabitants,  and  according  to  the  usual  ratio  of  cases 
of  insanity  to  population,  she  should  have  some 
twenty  thousand  insane,  or  even  if  she  were  a  much 
favored  nation  in  this  respect,  there  should  still  be 
ten  thousand  cases  within  her  borders.  But  the  fact 
before  us  is  that  the  whole  country  possesses  but  one 
lunatic  asylum,  located  at  Cairo,  and  its  daily  aggre- 
gate of  patients  rarely  exceeds  two  hundred  and 
fifty.  At  my  visits  in  December,  1891,  and  March, 
1892,  there  were  two  hundred  and  forty-eight. 

It  is  very  difficult  to  ascertain  the  reasons  for  this 
extraordinary  deficiency.  It  is  true  that  the  Koran 
teaches  that  the  insane  and  particularly  idiots  are 
holy  men,  that  their  souls  having  been  taken  to 
heaven,  their  bodies  are  without  mental  guidance. 
Therefore  the  Mussulmans  do  not  look  upon  the  in- 
sane as  sick  and  requiring  medical  supervision,  but 
as  the  happy  recipients  of  a  direct  blessing  from 
heaven.     This  is  quite  different  from  the  early  Chris- 

*Abstract  from  the  N.  Y.  Medical  Record,  May  21,  1892. 


24 

tian  belief  in  possession  by  devils.  Apoplexy  is  also 
regarded  by  Mohammedans  as  a  visitation  from  God, 
and  is  not  treated  medically.  '  It  is  also  true  that  the 
Egyptians,  unacquainted  with  hospitals,  object  to 
them,  and  prefer  to  care  for  their  sick  in  their  own 
homes  or  villages.  While,  therefore,  it  is  not  infre- 
quent to  meet  with  idiots  and  mildly  insane  people  in 
the  streets  of  Cairo  and  other  cities  and  towns,  and 
while  I  observed  several  at  various  times  in  places  in 
Upper  and  Lower  Egypt,  still,  taking  all  this  into 
consideration,  it  would  seem  to  be  impossible  to  ac- 
count for  the  extraordinarily  small  number  of  insane 
in  the  country  on  any  other  hypothesis  than  that  the 
percentage  of  insane  is  vastly  lower  here  than  any- 
where else  in  the  world. 

I  made  inquiries  of  native  physicians  at  various 
points  along  the  Nile,  such  as  Benisooef,  Minieh,  and 
the  like,  with  populations  varying  from  10,000  to 
30,000.  They  said  they  seldom  or  never  saw  insane 
people  in  their  practice,  since  they  were  not  con- 
sidered patients.  Of  course,  if  a  man  becomes  dan- 
gerous or  homicidal,  which  is  extremely  unusual,  he 
is  taken  into  custody  by  the  civil  authorities  and  sent 
to  the  Cairo  asylum.  Inquiries,  too,  in  the  villages 
gave  me  little  additional  information,  although  I 
would  hear  of  the  existence  of  imbeciles  or  mild 
types  of  insanity  in  some  of  these  places.  It  is  often 
the  custom  to  provide  them,  when  at  all  troublesome, 
with  places  to  sleep  in  the  desert  near  at  hand  and 
there  feed  them,  a  sort  of  colonization  system  for 
which  the  desert  offers  exceptional  advantages. 
There  is  no  one  to  annoy  there,  nothing  to  destroy 
or  hurt  one's  self  with,  and  one  can  be  as  noisy  as 
one  pleases  with  perfect  immunity. 

To  return  now  to  the  asylum  at  Cairo,  it  is  of  com- 
paratively recent  origin.  Although  Egypt  has  thrice 
been  the  medical  centre  of  the  whole  world  (once  in 
the  Twelfth   Dynasty,  again   in  the  time  of  Ptolemy 


25 

Euergetes,  and  lastly  under  the  Arabian  school),  we 
do  not  seem  to  find  evidence  of  the  existence  of  an 
asylum  for  lunatics  before  about  1280  a.d.,  at  which 
time  the  Mameluke  Kalaoon  founded  that  at  Cairo. 
The  patients  at  that  time  seem  to  have  been  well 
treated.  Harmonious  music  was  employed  for  the 
sleepless,  and  this  seems  to  be  a  very  early  use  of 
music  as  a  therapeutic  agent.  Story-telling  (a  com- 
mon custom  among  the  Egyptians),  dancing,  and 
light  comedy  were  features  of  the  treatment.  Subse- 
quently the  institution  degenerated.  Napoleon  in 
1800  made  some  improvements.  Many  of  the  patients 
were  then  in  chains.  In  1877  Dr.  A.  R.  Urquhart 
visited  them  in  an  abandoned  warehouse  across  the 
Nile  from  Cairo,  and  wrote  a  description  of  their  con- 
dition in  the  Journal  of  Mental  Science  for  April,  1879. 
The  following  are  excerpts  from  his  article  : 

"Amid  all  the  wonders  of  Cairo,  amid  the  mosques 
and  the  bazaars,  amid  the  gayeties  of  the  oriental 
Paris  sprung  up  under  the  fostering  care  of  the  Khe- 
dive, amid  the  gigantic  relics  of  that  wondrous  civili- 
zation of  ancient  Egypt,  there  is  no  more  melancholy, 
degrading  fact  than  their  common  madhouse. 
Dore  with  pencil  among  the  noisome  alleys  of  Lon- 
don, Dickens  with  pen  in  the  horrors  of  the  Fleet, 
have  made  us  familiar  with  miseries  and  loathsome- 
ness that  would  be  comfort  and  cleanliness  to  Les 
Miserables  of  Cairo.  Sprawling  on  the  uneven,  hard- 
trodden  floor  of  the  courtyard,  furiously  treading  its 
limited  space  crouching  in  its  filthy  recesses,  or  sur- 
rounding us  with  entreaties  and  menaces,  were  some 
two  hundred  hopeless  lunatics  in  various  stages  of 
nudity.  The  sun  was  beating  down  fiercely,  and  the 
stench  of  the  place  was  almost  unbearable." 

He  saw  six  or  eight  perfectly  naked  in  one  room 
whose  walls  were  smeared  with  filth  and  steaming 
with  urine;  and  one  loaded  down  with  chains. 


26 

Dr.  Tuke  made  a  somewhat  similar  report  of  a  visit 
in  an  article  in  the  same  journal  of  the  same  date. 

In  1880  the  warehouse  on  the  Nile  was  given  up 
and  the  asylum  transferred  to  quarters  which  it  now 
occupies  on  the  edge  of  the  desert  two  or  three  miles 
out  of  Cairo.  The  present  building  was  once  the 
apartment  of  the  black  slave-girls,  being  the  remains 
of  a  royal  palace  which  was  burned  in  1878.  Here 
it  was  that  Dr.  F.  M.  Sandwith  visited  the  lunatics  in 
t  883,  and  was  shocked  at  the  state  in  which  he  found 
them.  Filth,  hunger,  chains,  nakedness,  and  the 
whip  were  met  on  every  side.  The  following  year 
Dr.  Sandwith  and  a  native  pacha  were  made  chiefs 
of  the  Sanitary  Department  of  Egypt.  Under  Dr. 
Sandwith's  care  and  attention,  the  asylum  became 
transformed.  He  was  their  Pinel,  striking  off  the 
chains  of  the  poor  creatures,  and  opening  up  a  new 
era  in  their  miserable  lives.  One  chain  was  used  to 
fasten  the  ankles  to  the  floor,  and  others  were  used 
to  chain  the  wrists  to  heavy  staples  in  the  wall  near 
the  floor.  Thus  the  patient  was  obliged  to  keep  a 
more  or  less  recumbent  position,  and  a  bare  board 
was  provided  for  lying  upon.  There  were  no  official 
visitors,  and  the  chief  doctor  at  the  time  was  an 
Italian  Jew  without  a  diploma.  There  was  no  re- 
sponsibility anywhere.  Dr.  Sandwith  improved  the 
sewer  system  of  the  building,  which  was  in  a  horri- 
ble state,  struck  off  the  chains  of  the  patients,  put  in 
an  intelligent  young  doctor  with  a  Paris  diploma,  to- 
gether with  good  male  and  female  attendants,  clerk, 
storekeeper,  gardener,  carpenter,  matting-maker,  and 
the  like,  organized  fetes,  began  gardens,  which  are 
now  very  pretty  court-yards,  gave  them  better-lighted 
and  better-ventilated  wards,  and  new  bath-rooms, 
and  provided  a  better  regimen  and  sufficient  clothing. 
All  of  the  reforms  carried  out  were  described  in  a 
paper  in  the  Journal  of  Mental  Science  for  January, 
1889,  by  Dr.  Sandwith.     I  had  the  pleasure  of  mak- 


27 

ing  two  visits  to  the  institution,  the  last  time  in  the 
company  of  Dr.  Sandwuth.  The  first  time  I  came 
unexpectedly.  On  both  occasions  I  was  received  by 
Dr.  Emin  Bedr,  who  is  in  charge,  with  great  cor- 
diality, and  shown  everything  good  and  bad  about 
the  asylum.  Dr.  Bedr  is  a  Paris  graduate  and 
has  two  assistants,  one  a  graduate  from  the 
Cairo  Medical  School  and  the  other  a  student.  Re- 
straint is  only  rarely  employed,  and  when  needed 
consists  of  the  long-sleeved  camisole.  There  are  two 
or  three  padded  rooms,  such  as  they  have  in  the 
Bethlehem  Asylum  in  London,  which  are  occasionally 
of  great  service  in  the  treatment  of  the  insane.  There 
is  not  so  much  work  done  by  the  inmates  as  might 
be  were  there  more  ambition  on  the  part  of  the  medi- 
cal direction.  All  of  the  wards,  beds,  and  patients' 
clothing  were  neat  and  clean,  and  the  attendants,  in 
their  trim  uniforms,  seemed  to  be  very  kind  and  at- 
tentive to  their  charges.  But  the  nature  of  the 
Egyptians  is  gentle  and  kindly,  and  they  always  treat 
their  unfortunates  well.  They  are  only  unkind 
through  ignorance. 

There  is  much  that  is  interesting  in  the  forms  of 
insanity  met  with.  One  form  that  I  had  never  seen 
in  my  experience  in  American  asylums  is  that  result- 
ing from  the  use  of  cannabis  indica.  Of  the  two 
hundred  and  forty-eight  patients  sixty  men  and  four 
or  five  women  were  insane  from  the  excessive  use  ot 
hasheesh.  Acute  cases  which  recover  and  are  dis- 
charged are  almost  sure  to  return.  The  drug  is  al- 
most always  inhaled  by  smoking.  Hasheesh  has 
been  in  use  in  Egypt  for  over  six  hundred  and  fifty 
years,  and  although  the  Government  has  made 
strenuous  efforts  to  suppress  its  importation,  it  still 
continues  to  be  smuggled  in.  There  exist  in  Cairo, 
unknown  to  the  police,  several  hasheesh  joints.  I 
visited  one  of  these  one  evening  and  had  no  difficulty 
in  purchasing  samples    of  hasheesh  for  inspection. 


28 

There  were  two  or  three  rooms  full  of  men  enjoying 
their  pipes  and  chibouques.  The  drug  is  sold  in  square 
and  diamond-shaped  lozenges  of  a  black  extract, 
varying  from  two  cents  to  ten  cents  a  piece  according 
to  quality.  The  symptoms  produced  are  disorder  of 
the  alimentary  canal  (indigestion  and  diarrhoea),  in- 
creased appetite,  dilatation  of  the  pupils,  drooping 
eyelids,  anaemia,  general  debility,  and  delirium.  The 
earliest  mental  symptom  is  a  marked  and  increasing 
timidity,  sometimes  amounting  to  ^folie  du  doute,  or 
an  agoraphobia.  Very  many  cases  result  in  chronic 
insanity,  dementia,  or  death. 

The  use  of  wine  and  other  intoxicating  beverages 
is  forbidden  by  the  Koran,  and  the  Egyptians  are  a 
very  temperate  people.  Hence  insanity  from  al- 
coholism is  exceedingly  uncommon.  There  were 
only  two  or  three  cases  of  alcoholic  insanity  in  the 
asylum  at  the  time  of  my  visit. 

Religion  is  often  the  cause  of  insanity,  or  if  not  the 
direct  cause,  often  colors  the  delusions.  One  would 
expect  that  a  religion  which  so  commonly  gives  rise 
to  extremes  of  fanaticism,  to  the  orders  to  be  seen  in 
Cairo  of  Howling  and  Dancing  Dervishes,  to  the 
desert  pilgrimages  to  Mecca,  to  constant  poring  over 
the  Koran  and  the  like,  would  have  a  more  than 
usually  bad  effect  upon  the  mental  balance.  It  is 
surely  to  the  influence  of  the  desert  that  we  owe  the 
appearance  of  so  many  false  prophets.  The  desert 
has  the  peculiarity  of  developing  thoughts  in  great 
luxuriance,  even  if  nothing  else  grows  there.  If 
there  is  anything  morbid  in  one's  mind  it  will  grow 
like  an  exotic  there  where  there  is  nothing  else  to 
think  about.  There  are  a  great  many  false  prophets 
in  the  Cairo  asylum.  The  Mahdi  was  another  in- 
stance. Mahomet  was  one,  and  there  have  been 
others  almost  as  famous  if  not  as  influential.  It  may 
be  surmised  that  where  polygamy  exists  as  it  does  in 


29 

Egypt,  and  where  divorce  can  be  effected  at  will  by 
the  husband,  domestic  unhappiness  should  be  a  fre- 
quent cause  of  insanity  among  the  women. 


General  paralysis  is  very  rare,  and  it  has  yet  to  be 
proven  that  it  even  exists  among  Egyptians.  Dr. 
Schirs,  in  nineteen  years  in  Cairo,  saw  five  cases,  but 
none  were  in  Egyptians.  Dr.  Sandwith,  who  has 
practised  in  Cairo  eight  years  and  been  a  frequent 
visitor  at  the  asylum,  has  yet  to  see  a  case  of  general 
paresis  in  an  Egyptian,  and  altogether  has  seen  only 
several  in  orientals.  On  the  day  of  my  visit  to  the 
Cairo  institution,  four  cases  were  pointed  out  to  me 
by  Dr.  Bedr  as  dementia  paralytica,  but  examination 
showed  that  three  of  them  were  decidedly  not  paresis, 
while  the  fourth  was  doubtful.  This  fourth  case  pre- 
sented a  few  uncertain  symptoms  of  general  paralysis 
and  was  a  Copt.  It  is  rather  difficult  to  explain  such 
a  rarity  of  this  disease,  while  just  across  the  sea,  in 
Greece,  it  is  unusually  common.  *  *  *  Dr.  Sand- 
with thinks  it  may  have  something  to  do  with  the 
food,  for  the  Egyptians  are  almost  perfect  vegeta- 
rians. 

The  Cairo  asylum  would  be  a  good  school  for  a 
study  of  craniometry  and  racial  characteristics. 
Among  the  patients  I  saw  there  were  Egyptians, 
Copts,  Nubians,  Soudanese,  Abyssinians,  Turks, 
Greeks,  Syrians,  Circassians,  Jews  and  Bedouins.  A 
difficulty  in  the  way  of  cranial  measurements  would 
be  the  scalp  disease,  from  which  it  would  seem  that 
almost  no  patient  is  free — favus.  And  the  preva- 
lence of  ophthalmic  disorders  among  all  classes  of 
people  in  the  country  interferes,  as  I  very  often  found 
during  my  sojourn,  with  diagnosis,  not  only  in  some 
of  the  nervous  disorders,  but  also  in  the  mental  cases. 


Contents 


WINTERING  IN  EGYPT. 


THE  BATHS   OF  HE L WAN. 


THE  INSANE  IN  EGYPT. 


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